A Surgeon Perspective on One Patient's Spondylolisthesis

Mr. Nelson's condition, "
spondylolisthesis," is forward slippage of one vertebrae on top of another. This causes pain, including pain that radiates to the legs, because it creates compression of nerves in the spinal canal as well as in the "foramen," or windows where the spinal nerves exit out the sides of the spinal canal.

The traditional surgical approach, which is often used at BIDMC and elsewhere, is to perform open anterior lumbar interbody fusion (ALIF) on one day, followed by open posterior fusion with screws and rods on another day. This means a 10-day recovery in the hospital and a six-month recovery at home.

In Mr. Nelson's case, he was the ideal patient for a newer procedure called
direct lateral interbody fusion (DLIF), because of the kind of spondylothesis he had. Also, he was intelligent and mechanically minded -- savvy enough to understand the differences in the two approaches and make an informed choice.

I performed DLIF, and in the same surgery inserted percutaneous pedicle screws in the back. This further reduced the invasiveness of the surgery by avoiding disruption of the para-spinal muscles in the back.

Mr. Nelson left the hospital the next morning. When I visited with him in the office several weeks later, he said "I may as well admit: I've been back to work." So while a patient who underwent the open procedure would still have been trying to walk, he was back on the job, having returned to his normal way of life with much less pain.